Marilee Monnot

Neurology of affective prosody and its functional-anatomic organization in right hemisphere

Unlike the aphasic syndromes, the organization of affective prosody in brain has remained controversial because affective-prosodic deficits may occur after left or right brain damage. However, different patterns of deficits are observed following left and right brain damage that suggest affective prosody is a dominant and lateralized function of the right hemisphere. Using the Aprosodia Battery, which was developed to differentiate left and right hemisphere patterns of affective-prosodic deficits, functional-anatomic evidence is presented in patients with focal ischemic strokes to support the concepts that (1) affective prosody is a dominant and lateralized function of the right hemisphere, (2) the intrahemispheric organization of affective prosody in the right hemisphere, with the partial exception of Repetition, is analogous to the organization of propositional language in the left hemisphere and (3) the aprosodic syndromes are cortically based as part of evolutionary adaptations underlying human language and communication.

Human Facial Expressions Are Organized Functionally Across the Upper-Lower Facial Axis

Most clinical research has focused on intensity differences of facial expressions between the right and left hemiface to explore lateralization of emotions in the brain. Observations by social psychologists, however, suggest that control of facial expression is organized predominantly across the upper-lower facial axis because of the phenomena of facial blends: simultaneous display of different emotions on the upper and lower face. Facial blends are related to social emotions and development of display rules that allow individuals to sculpt facial expressions for social and manipulative purposes. We have demonstrated that facial blends of emotion are more easily and accurately posed on the upper-lower than right-left hemiface, and that upper facial emotions are processed preferentially by the right hemisphere whereas lower facial emotions are processed preferentially by the left hemisphere. Based on these results, recent anatomical studies showing separate cortical areas for motor control of upper and lower face and the neurology of posed and spontaneous expressions of emotion, a functional-anatomic model of how the forebrain modulates facial expressions, is presented. The unique human ability to produce facial blends of emotion is, most likely, an adaptive modification linked to the evolution of speech and language. NEUROSCIENTIST 13(5):433—446, 2007.

Relationship of leukoaraiosis to cognitive decline and cognitive aging

Objective:Leukoaraiosis (LA) is a common finding on MRI scans of the elderly. However, its exact relationship to cognitive decline and dementia is in dispute. Because LA involves the paracallosal white matter, we sought to determine if LA, uncomplicated by ischemic lesions or complaints of cognitive impairment, is associated with cognitive loss or difficulties with interhemispheric integration of behavioral functions. Methods:Two hundred fifty-seven MRI scans with deep white matter changes were screened. After a chart review, 38 patients had uncomplicated LA, and 31 gave informed consent to undergo cognitive and behavioral testing. Results:LA severity was not related to any of the cognitive or behavioral assessments. However, some dependent measures showed medium effect sizes that were in keeping with published findings, indicating that LA has a marginal impact on cognition. In comparison, robust relationships with age were found for certain tasks, suggesting that our cohort size was sufficient to detect meaningful clinical relationships. Conclusion:Based on statistical interpretations using effect sizes, LA severity may be better viewed as a biomarker for physiological brain aging that is in advance of chronological age, leaving the elderly individual at greater risk for developing dementia.

Acoustic Analyses Support Subjective Judgments of Vocal Emotion

Abstract: Subjective human judgments of emotion in speech have been considered to be less reliable than acoustic analyses in scientific studies, but acoustic analyses have had limited ability to detect subtle vocal nuances that give useful social information about human intent and meaning to discourse partners. Two post hoc analyses were undertaken to determine if results from acoustic analyses of vocalizations were related to subjective judgments of vocal affect (affective prosody). Acoustic analyses of fundamental frequency (Fo) and subjective judgments of emotional content of vocal productions from two studies underwent statistical analyses: Study 1—vocal repetition of sentences using 6 basic emotions in 24 detoxified alcoholics and 15 controls; study 2—quality/quantity of “motherese” speech directed to 52 infants in Cambridge, England. Ratings of emotion indicators for both studies were done by female researchers of different ages and cultural/language backgrounds. In both studies, acoustic analyses of Fo elements in utterances accounted for approximately 50% of the effect when modeling subjective emotion accuracy and emotion intensity ratings, using linear regression analyses. Acoustic analyses of Fo are positively associated with subjective judgments of emotion indicators, and speakers who cannot vary Fo are unable to convey emotion accurately to communication partners. Yet acoustic analyses are limited in comparison to the exquisite complexity of the human auditory and cognitive systems. Subjective judgments of emotional meaning in speech can be a reliable variable in scientific inquiry and can be used for more complex, subtle studies of speech communication and intentionality than acoustic analyses.

Behavioural abnormalities associated with rapid deterioration of language functions in semantic dementia respond to sertraline.

Frontotemporal dementia (FTD) consists of three main clinical syndromes: (1) frontal variant FTD presenting predominantly with behavioural abnormalities, (2) semantic dementia presenting with fluent aphasic deficits and (3) primary progressive aphasia presenting with non-fluent aphasic deficits.1 By definition, major behavioural abnormalities are not present in the initial stages of semantic dementia.1 However, we have observed that significant behavioural problems may occur in some patients with semantic dementia when both comprehension and verbal output deteriorate rapidly. These behavioural abnormalities appear to respond favourably to low-dose sertraline. This study was approved by the Institutional Review Board of the University of Oklahoma in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. Four non-institutionalised patients, two women and two men, who received care at the Center for Memory Loss and Dementia (CMLD) at the University of Oklahoma Health Sciences Center were diagnosed as having semantic dementia between 15 July 2004 and 30 December 2006. All patients fulfilled clinical criteria for FTD1 and had a complete diagnostic evaluations for dementia, including neuropsychological testing, Clinical Dementia Rating Scale (CDR), Mini-Mental State Examination (MMSE) and the Neuropsychiatric Inventory Questionnaire (NPI-Q).2 Brain MRI and PET studies in all four patients showed significant left temporal and, to a lesser degree, left …

Decoding facial blends of emotion: visual field, attentional and hemispheric biases.

Most clinical research assumes that modulation of facial expressions is lateralized predominantly across the right-left hemiface. However, social psychological research suggests that facial expressions are organized predominantly across the upper-lower face. Because humans learn to cognitively control facial expression for social purposes, the lower face may display a false emotion, typically a smile, to enable approach behavior. In contrast, the upper face may leak a persons true feeling state by producing a brief facial blend of emotion, i.e. a different emotion on the upper versus lower face. Previous studies from our laboratory have shown that upper facial emotions are processed preferentially by the right hemisphere under conditions of directed attention if facial blends of emotion are presented tachistoscopically to the mid left and right visual fields. This paper explores how facial blends are processed within the four visual quadrants. The results, combined with our previous research, demonstrate that lower more so than upper facial emotions are perceived best when presented to the viewers left and right visual fields just above the horizontal axis. Upper facial emotions are perceived best when presented to the viewers left visual field just above the horizontal axis under conditions of directed attention. Thus, by gazing at a persons left ear, which also avoids the social stigma of eye-to-eye contact, ones ability to decode facial expressions should be enhanced.

Deficits in Affective Prosody Comprehension: Family History of Alcoholism versus Alcohol Exposure

BACKGROUND Abstinent alcoholics have deficits in comprehending the affective intonation in speech. Prior work suggests that these deficits are due to alcohol exposure rather than preexisting risk factors for alcoholism. The present paper examines whether family history of alcoholism is a contributor to affective prosody deficits in alcoholics. METHODS Fifty-eight healthy, nonabusing young adults with and without a family history of alcoholism or other substance abuse (29 FH+ and 29 FH-) were compared on affective prosody comprehension using the Aprosodia Battery. A secondary analysis was done comparing affective prosody comprehension in FH+ and FH- detoxified alcoholics from an earlier study (17 FH+ and 14 FH-). RESULTS Performance on the Aprosodia Battery was not related to FH status in either the healthy, nonabusing sample or in the detoxified alcoholic group. CONCLUSIONS The present study lends support to previous research suggesting that deficits in affective prosody comprehension observed in detoxified alcoholics are associated with a history of heavy drinking rather than with a family history of alcoholism.

Reversible dementia with parkinsonian features associated with budesonide use

A 51-year-old man was referred for neurologic consultation because of increasing forgetfulness, difficulty walking, frequent falls, apathy, and decreased motivation to perform activities of daily living such as bathing, cooking, and driving, over a 6-month period. He had a history of Crohn disease (CD), diabetes, and coronary artery disease. Current medications included amlodipine, rosiglitazone, hydrochlorothiazide, and budesonide. He was treated with oral prednisone for CD in the past with excellent response. Two years before evaluation, he developed multiple side-effects including weight gain, edema, and hypertension that precluded the use of prednisone. Nine months prior to his presentation, he was started on oral budesonide at 9 mg/day. He tolerated the new medication well and had none of the side-effects previously noted. However, he experienced a relapse of his CD 6 weeks after an attempt was made to discontinue budesonide, and the medication was restarted. On initial examination, he had a Mini-Mental State Examination (MMSE) score …

Changing Relative Prevalence of Alzheimer Disease versus Non-Alzheimer Disease Dementias: Have We Underestimated the Looming Dementia Epidemic?

The relative prevalence of neurodegenerative dementias in our Veterans’ Affairs dementia clinic has shifted from predominantly Alzheimer disease (AD) to predominantly non-AD diagnoses. Because our clinic was the only Veterans’ Affairs clinic in Oklahoma that could initiate cholinesterase inhibitors, we had a captured patient referral source. If future epidemiologic studies establish that non-AD dementias are as, or more, prevalent than AD, then the looming dementia epidemic in the United States will be greater in magnitude than currently predicted.

INITIATING REFERRAL IN MILD COGNITIVE IMPAIRMENT: WHO RINGS THE BELL?

The Heimlich maneuver can be effectively used in relieving upper airway obstruction from foreign bodies. Complications associated with this procedure can involve intrathoracic or intra-abdominal organs, but they are infrequent. Few case reports of acute abdominal aortic thrombosis after the Heimlich maneuver have been reported in the literature. Of these, a patient with no history of abdominal aortic aneurysm survived. In our case, application of the Heimlich maneuver might have caused rupture of atherosclerotic plaques in the abdominal aortic arch with resulting formation of the arterial thrombus. The pathogenesis of the thrombosis can be from the rupture of an atherosclerotic plaque with the Heimlich maneuver, the shift in the posture of the patient during the event, or direct trauma to the aneurysm. Despite the patient being maintained on chronic warfarin therapy for his previously diagnosed deep venous thrombosis, a continued hypercoagulable state cannot be excluded as a contributing factor, and the presence of pulmonary embolism and history of deep venous thrombosis would support this. Additionally, because our patient was slender, the location of the arterial thrombus in the infrarenal region of the aorta could be related to direct transmission of pressure from inadvertent malposition of the hands during the maneuver.